23 Million Americans Would Be Uninsured If the GOP Health Care Bill Becomes Law

UPDATE, May 24, 2017: On Thursday the non-partisan Congressional Budget Office released a report detailing the impact the Republican health care bill would have if it became law. Much like the score given to the initial version of the American Health Care Act, the CBO's latest assessment does not bode well for the future of the House GOP's proposed Obamacare replacement.

According to the CBO analysis, 14 million people would lose their health insurance by next year, with 23 million expected to lose coverage by 2026 (this number is just slightly less than the CBO report on the initial version of the AHCA, which would have left 24 million without insurance over the same time frame). Premiums would "vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums," according to the report. And because the bill would allow states to waive the essential health benefits protected by Obamacare—like maternity care and mental health treatment—health care costs could skyrocket for millions of Americans.

"Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits," the report said. "In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services."

Following the bill's passage in the House earlier this month, Senate Majority Leader Mitch McConnell (R-Ky.) indicated that the Senate would likely revise the bill—or scrap it entirely and start anew—before voting on it. But if the CBO report is any indication, it seems uncertain that Senate Republicans will have enough support to pass any health care measure.

“I don’t know how we get to 50 at the moment,” McConnell told Reuters on Wednesday. “But that’s the goal.”

Prominent Senate Democrats have already slammed the GOP health care plan—"Republicans were haunted by the ghost of CBO scores past, so they went ahead without one,” said Senate Minority Leader Chuck Schumer (D-N.Y.); California Senator Kamala Harris tweeted that the AHCA was "just as terrible as we thought it was"—but following Wednesday's report, Republicans have joined the outcry and publicly denounced the bill.

"The goal of any ACA replacement should be to improve access to quality health care while providing consumers with more choices and restraining costs," said Senator Susan Collins (R-Maine) in a statement. "Unfortunately, the CBO estimates that 23 million Americans would lose insurance coverage over the next decade, and the impact would disproportionately affect older, low-income Americans."

House Speaker Paul Ryan, however, continued to stand by his proposed legislation.

"This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit," the Wisconsin congressman said in a statement. "It is another positive step toward keeping our promise to repeal and replace Obamacare."

This post was originally published on May 4, 2017:

It finally happened: After seven years the House of Representatives voted in favor of repealing and replacing the Affordable Care Act.

After the initial version of the Republican's proposed replacement, the American Health Care Act, was pulled in late March, the House GOP scrambled to revise the legislation to ensure a swift and successful vote. Unlike its first iteration, this new version of the AHCA did not have time to be fully audited by the Congressional Budget Office to determine how it would impact Americans (remember, when it was first reviewed, the CBO said at least 24 million people would lose health insurance under the GOP's plan). However, considering what actually went into this bill, it's no surprise that Republicans were itching to push it through before the general public could actually learn how devastating it could be to millions of Americans—particularly when it comes to women's health.

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To put it simply, the American Health Care Act, otherwise known as Trumpcare, has the potential to severely undermine the care and treatment that women receive. Thanks to two Republican congressmen—Tom MacArthur of New Jersey and Florida's Mark Meadows—and their eponymous McArthur-Meadows Amendment, states would be given the option to waive the ACA's ban on denying coverage to those with preexisting conditions. This includes ailments like asthma, diabetes, and cancer but also applies to sexual assault. Before the ACA became law in 2010, rape was considered a preexisting condition—one that could be used to deny coverage to any woman who survived such a horrific event. In fact, this was exactly what happened to Christina Turner in 2002 after she was drugged and raped. Turner was in counseling and had been prescribed anti-HIV medication by her doctor as a preventive measure following the attack when she was dropped by her insurance company and unable to obtain new coverage.

Beyond sexual assault, things like postpartum depression, C-sections, and domestic violence are all deemed preexisting conditions and could be cited as reasons to charge sky-high premiums and ultimately keep people from obtaining affordable insurance. According to the language in the MacArthur-Meadows Amendment, "Nothing in [the AHCA] shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender." But considering how woman-specific things like postpartum depression and C-sections are—and the much higher rates that domestic violence and sexual assault affect women—it's hard to argue that this bill does anything but make being a woman a preexisting condition.

This becomes even more evident in another provision of the MacArthur-Meadows Amendment, which gives states the ability to waive coverage for the essential health benefits outlined under the ACA. Among those benefits: preventive care (like mammograms and gynecological checkups), prescription drugs, mental health treatment, and pregnancy, maternity, and newborn care. If states opt out of these benefits, it is not far-fetched to see a return to the pre-2010, pre-ACA health care system—one in which 88 percent of insurance plans did not include maternity coverage. Because of a "little-noticed provision" in the AHCA, detailed by The Wall Street Journal, the possibility of waiving these essential benefits could also expand to plans offered by large employers—meaning that up to half the country could lose the protections set in place by the ACA.

And as a final blow: In direct contradiction to Trump's campaign promise not to cut Medicaid, Trumpcare cuts the government health care program by $880 billion over the next 10 years—throwing millions of low-income women and children off their insurance plans (it's particularly devastating for school-based programs that serve special-needs students). It also blocks federal funding to Planned Parenthood, which comes primarily from Medicaid reimbursements. This means that an estimated 390,000 women, many of whom are low-income, could lose care, and another 650,000 could see reductions in preventive services.

For the men in Congress who wrote the legislation, however, there's no need for them to worry about what will happen to their health care. A legislative loophole would keep the ACA protections in place for the representatives and their staffers. Rep. MacArthur wrote separate legislation to close the loophole, as Vox explains, it could easily be stalled if it heads to the Senate. Facing similar uncertainty: How Trumpcare will fare once it, too, makes it to the Senate. If it passes at all, it will likely come only after it undergoes major revisions. But regardless of Trumpcare's fate, the House GOP is sending a clear message to voters: While millions may suffer under their health care plan, the representatives who voted for it can rest easy knowing that, whatever happens, they will not.